Z Codes By Valerie Fernandez, MBA, CPC, CPC-H, AHIMA ICD-10 Trainer ICD-10-CM Z codes (categories Z00 – Z99) are used to report factors influencing health status and contact with health services. They are found in Chapter XXI in the ICD-10 book and may be used in any healthcare setting. They can be reported as a principal diagnosis in an inpatient setting, and may be listed either as a primary or secondary diagnosis in an outpatient setting, based on the type of encounter. The Z20–Z28 category of codes relates to contact with or exposure to communicable diseases. some codes designate exposure, such as Z20.01, “Contact with intestinal infectious diseases, escherichi coli (e. coli).” Other codes in this range indicate disease-related contacts, such as Z23, “encounter for immunization,” or Z28.01, “Immunization not carried out because of acute illness of patient.” status codes can provide information about the presence of a prosthetic device, such as Z96.651, “Presence of right artificial knee joint” for a knee prosthesis. another example is Z94.1, “Heart transplant status.” Types of status codes include genetic carrier of a disease, Z14.1, “Cystic Fibrosis carrier;” Z16.2, “Resistance to antimicrobial drugs;” and Z18.12, “Other antibiotics and retained foreign body fragments, non-metal,” to name a few. Do not resuscitate status, DnR, is reported using Z66. When patients have an office visit, vital signs that include height, weight, and temperature are typically taken. When a patient is obese, it is important to provide information about the patient's body mass index (BmI). BmI is easily calculated by hand or by using electronic tools, and most emRs will automatically calculate it. The table on this page provides a guideline for the Obesity Class based on the calculated BmI. To report BmI as a diagnosis accurately, the weight used in the calculation must be measured by the provider and cannot be stated by the patient. Tracking BmI is important for patients who are underweight as well as for those who surpass the normal height and weight categories. an individual is considered underweight if his or her BmI is under 18.5 and obese if his or her BmI is between 30 and 34.9. morbid obesity is classified for individuals with a BmI over 40, and super morbid obesity is listed when the patient has a BmI over 50. ICD-9 and ICD-10 have similar classifications for obesity and BmI, so the transition to the new code set should be a smooth one for this series of diagnosis codes. ICD-10 The BmI classification is different for adults and children. The table below lists some of the Z codes for BmI. Adult BMI (Example Codes) Pediatric BMI (All Codes) Z68.1: 19 or less . . . . . . . . . Z68.51: under 5th percentile for age Z68.32: 32.0–32.9 . . . . . . . Z68.52: 5th to below 85th percentile for age Z68.36: 36.0–36.9 . . . . . . . Z68.53: 85th to below 95th percentile for age Z68.44: 60.0–69.9 . . . . . . . Z68.54: 95th percentile or above for age some examples of other Z codes are: personal history diagnosis codes (they are found in Chapter XXI), which include Z88.0, “allergy status to Penicillin,” and Z87.891, “Personal history of nicotine dependence.” Counseling services include assisting patients in coping with other problems related to lifestyle, Z72.9. For pregnancy and childbirth, Z codes enable a provider to document the weeks of gestation as well as the outcome of the delivery. a sample, in the chart below, highlights gestational age, outcome of delivery, and the corresponding ICD-10 diagnosis codes. Z codes offer the ability to document a variety of health services, Gestational Age ICD-10 Code Delivery Outcome ICD-10 Code 10 weeks . . . . . . . Z3a10 . . . . . . . . single live born . . . . . Z37.0 20 weeks . . . . . . . Z3a20 . . . . . . . . Twins . . . . . . . . . . . . . Z37.2 30 weeks . . . . . . . Z3a30 . . . . . . . . Triplets. . . . . . . . . . . . Z37.51 including routine examinations such as Z00.0, “adult encounter without complaint or reported diagnosis,” which can be used for a general well visit. Overall, ICD-10-Cm Z codes enable a provider to submit claims with exceptional detail about the patient’s health status, family and personal history, and conditions influencing health status. Valerie is an AHIMA certified trainer for ICD-10 CM and ICD-10 PCS and participates in their Ambassador program for ICD-10. Currently, she is the ICD-10 quality assurance manager for Special Surgery in New York. She also holds a CPC and CPC-H from the American Academy of Professional Coders (AAPC). THe jOuRnal OF THe HealTHCaRe BIllIng anD managemenT assOCIaTIOn 35
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